Resp & Qualifications

PURPOSE:
Plan, organize and direct a diverse staff and activities to improve Government Programs Quality, NCQA Health Plan and Health Equity Accreditation, & Healthcare Effectiveness Data and Information Set (HEDIS) performance, across Medicaid and Medicare populations. Develop and operationalize innovative programs and interventions to address a multi-year plan for quality Improvement, that meet state regulatory and accreditation activities across Government Programs populations. Serve as a quality champion through measuring, monitoring, and reporting the quality and effectiveness of work processes that impacts Accreditation, customer satisfaction, HEDIS & STARS performance.

ESSENTIAL FUNCTIONS:

Directs the day-to-day prioritization of work and management of clinical and non-clinical Quality Improvement and Population Health staff, analysts and HEDIS operational staff, including vendor relationships supporting quality. Ensures the implementation and ongoing execution of cross-functional Quality Improvement initiatives improves HEDIS performance, customer satisfaction & members quality of care.
In conjunction with Vice President of Quality/Stars & cross functional teams develops, prioritizes, and operationalizes innovative Government Programs quality improvement opportunities into programs and interventions. Creates and delivers data-driven storylines and presentations on identified opportunities and potential high-impact solutions that persuades & engages leadership, regulatory bodies, industry and cross-functional teams.
Continuously evaluates & trends the health plan quality performance using evidence based and data-driven approaches against the market/industry performance. Oversees development and communication of scorecards outlining the progress/trends of quality goals along with outcomes, efficacy & barriers (if any) of corporate-wide quality programs, initiatives, and interventions.
Maintains knowledge of current and future NCQA, NQF, CMS/Federal, State, regulatory and healthcare quality measurement requirements, and accreditation standards and HEDIS. Actively participates in or chairs committees, sub-committees, enterprise & Industry workgroups as assigned to report, champion an advocate quality improvement, across populations.
Directs the strategic and the day-to-day activities of the Quality Department, including coaching and guiding individuals and teams in order to implement departmental, divisional, and organizational mission/goals. Recruits, retains and develops a high performing team. Evaluates performance of each team member, generates development plans and sets goals within the context of the corporate policies and procedures. Develops annual goals, and prepares, monitors, and analyzes variances of departmental budgets in order to control and appropriately allocate resources.

SUPERVISORY RESPONSIBILITY:
This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree in business administration, health policy, health services research, public health, economics, mathematics, computer science, or a related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience:

8 years experience in a healthcare, public health, health insurance, quality/process improvement or data management business environment.
3 years management experience.

Preferred Qualifications:

Training or certification in Quality or Process Improvement Methods
Clinical Qualification (RN/NP/PharmD)
Data Analytics & Visualizations

Knowledge, Skills and Abilities (KSAs)

Ability to perform qualitative and quantitative data analyses and create innovative strategies and work with colleagues to address findings.
Ability to learn the technical aspects of collection and reporting of both administrative and clinical aspects of quality measures.
Strong computer skills to include Microsoft Office.
Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed. Ability to lead and direct analysts, clinicians and project/program managers.
Public speaking and presentation skills.
Deep understanding of the Customer Experience.
Experience in Population Health Management concepts.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $140,320 - $260,469
Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department

Quality and Accreditation
Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply

Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship
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